Abstract
Background Neonatal asphyxia is often associated with hepatic injury. We hypothesized that this
might lead to increased bilirubin concentrations.
Study Design Term neonates admitted between January 2015 and April 2017 who remained hospitalized
for ≥ 4 days and who had serial serum bilirubin concentrations recorded were divided
into those with neonatal encephalopathy (NE) and controls. Serial serum bilirubin
concentrations during the first days of life were compared between groups.
Results Twenty-nine neonates with NE and 84 age-matched controls were identified. Mean total
serum bilirubin concentrations of NE babies were significantly lower than those controls
throughout the first days of life. At 96 hours of age, NE serum bilirubin concentrations
were 4.5 (3.2, 5.8) versus controls of 10.5 (9.4, 11.5) mg/dL (p < 0.0001). The mean area under the curve (AUC) for the NE group was 268 (215, 321)
versus 663 (608, 718), p < 0.0001, for the control group. All of the NE babies remained below the 40th percentile
of the Bhutani curve and none required phototherapy.
Conclusion Contrary to our hypothesis, bilirubin concentrations in NE infants are significantly
lower than expected during the first 4 days postnatally. We speculate that, under
conditions of severe oxidative stress, bilirubin is consumed as an antioxidant.
Keywords
bilirubin - antioxidant - Gamma-glutamyltransferase - aspartate transferase - alanine
transferase
